Respiratory status of adult patients in the postoperative period of thoracic or upper abdominal surgeries

descriptive, cross-sectional study developed with 312 patients. Eighteen NOC indicators were assessed and rated using a Likert-scale questionnaire and definitions. Descriptive and correlative analysis were conducted.

Results:

the most compromised clinical indicators were coughing (65.5%), auscultated breath sounds (55%), and respiratory rate (51.3%). Factors associated with worse NOC ratings in specific clinical indicators were sex, age, pain, and general anesthesia.

Conclusions:

certain clinical indicators of respiratory status were more compromised than others in postoperative patients. Patient and context-related variables can affect the level of respiratory compromise.

Descriptors:
Postanesthesia Nursing; Nursing Assessment; Adult Health; Outcome Assessment (Health Care); Respiratory System; Postoperative Care

Authorship

Alana Gomes de Araujo Almeida

RNRNBrazilBrazilRN

Lívia Maia Pascoal

PhD, Adjunct Professor, Centro de Ciências Sociais, Saúde e Tecnologia, Universidade Federal do Maranhão, Imperatriz, MA, BrazilUniversidade Federal do MaranhãoBrazilImperatriz, MA, BrazilPhD, Adjunct Professor, Centro de Ciências Sociais, Saúde e Tecnologia, Universidade Federal do Maranhão, Imperatriz, MA, Brazil

Francisco Dimitre Rodrigo Pereira Santos

MSc, Assistent Professor, Universidade do Sul do Maranhão, Imperatriz, MA, BrazilUniversidade do Sul do MaranhãoBrazilImperatriz, MA, BrazilMSc, Assistent Professor, Universidade do Sul do Maranhão, Imperatriz, MA, Brazil

Pedro Martins Lima Neto

MSc, Assistent Professor, Centro de Ciências Sociais, Saúde e Tecnologia, Universidade Federal do Maranhão, Imperatriz, MA, BrazilUniversidade Federal do MaranhãoBrazilImperatriz, MA, BrazilMSc, Assistent Professor, Centro de Ciências Sociais, Saúde e Tecnologia, Universidade Federal do Maranhão, Imperatriz, MA, Brazil

Simony Fabíola Lopes Nunes

Vanessa Emille Carvalho de Sousa

PhD, Visiting Professor, Instituto de Ciencias da Saúde, Universidade da Integração Internacional da Lusofonia Afro-brasileira, Redenção, CE, Brazil,Universidade da Integração Internacional da Lusofonia Afro-brasileiraBrazilRedenção, CE, BrazilPhD, Visiting Professor, Instituto de Ciencias da Saúde, Universidade da Integração Internacional da Lusofonia Afro-brasileira, Redenção, CE, Brazil,

Corresponding Author: Lívia Maia Pascoal Universidade Federal do Maranhão Imperatriz s/n CEP: 65900-000, MA, Brazil E-mail: livia_mp@hotmail.com

1
Financial Support: Fundação de Amparo a Pesquisa do Maranhão - Fapema

SCIMAGO INSTITUTIONS RANKINGS

RNRNBrazilBrazilRN

Tables

Tables (4)

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Table 1
Distribution of patients according to smoking, type of surgery, type of anesthesia, complaints, and vital parameters. Imperatriz, MA, Brazil, 2014-2015

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Table 2
Distribution of Nursing Outcomes Classification (NOC) indicators of Respiratory Status by level of severity. Imperatriz, MA, Brazil, 2014-2015

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Table 3
Correlations between Nursing Outcomes Classification (NOC). indicators and personal characteristics of the patients. Imperatriz, MA, Brazil, 2014-2015

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Table 4
Correlations between Nursing Outcomes Classification (NOC). indicators and clinical characteristics of the patients. Imperatriz, MA, Brazil, 2014-2015

Table 1 Distribution of patients according to smoking, type of surgery, type of anesthesia, complaints, and vital parameters. Imperatriz, MA, Brazil, 2014-2015

Variables		N*			%
Smoking
	Never smoker	175			56.5
	Passive smoker	18			5.8
	Quitter smoker	42			13.5
	Current smoker	75			24.2
Type of Surgery
	Exploratory laparotomy	244			78.2
	Thoracotomy	66			21.1
	Cholecystectomy	46			14.7
	Appendectomy	32			10.3
	Other	50			16.9
Type of anesthesia
	Local or regional anesthesia	204			70.6
	General anesthesia	85			29.4
Complaints
	Pain	177			57
	Cough	105			33.6
Vital parameters		N ^†	Min	Max	Mean	SD
	Respiratory rate	312	11	50	21.29	4.45
	Heart rate	312	42	132	80.40	16.32
	SpO ₂	309	61	99	93.91	3.97

*N - Some patients were submitted to more than 1 type of surgery, †N - Variations in N ocurred because not all questions were answered by all subjects.

Table 2 Distribution of Nursing Outcomes Classification (NOC) indicators of Respiratory Status by level of severity. Imperatriz, MA, Brazil, 2014-2015

NOC Indicators*	Severe		Substantial		Moderate		Mild		None
NOC Indicators*	n	%	n	%	n	%	n	%	n	%
Coughing	7	6.4	8	7.3	8	7.3	49	44.5	38	34.5
Auscultated breath sounds	34	10.9	50	16.1	33	10.6	54	17.4	140	45.0
Respiratory rate	8	2.6	6	1.9	30	9.6	116	37.2	152	48.7
Oxygen saturation	3	1.0	5	1.6	26	8.4	110	35.6	165	53.4
Accessory muscle use	8	2.6	9	2.9	36	11.6	84	27.0	174	55.9
Depth of inspiration	5	1.6	--	--	8	2.6	78	25.2	218	70.6
Adventitious breath sounds	4	1.3	4	1.3	12	3.9	28	9.0	262	84.5
Respiratory rhythm	2	0.6	6	1.9	5	1.6	28	9.1	268	86.7
Chest retraction	--	--	5	1.6	10	3.2	23	7.4	273	87.8
Dyspnea with mild exertion	17	5.4	--	--	17	5.4	1	0.3	277	88.8
Accumulation of sputum	4	1.3	4	1.3	7	2.3	13	4.2	282	91.0
Dyspnea at rest	5	1.6	4	1.3	2	0.6	4	1.0	298	95.5
Diaphoresis	--	--	4	1.3	6	1.9	3	1	296	95.8
Somnolence	2	0.6	5	1.6	2	0.6	4	1.9	293	95.1
Pursed lips breathing	2	0.6	--	--	--	--	5	1.6	303	97.7
Cyanosis	--	--	5	1.6	--	--	1	0.3	304	98.1
Restlessness	--	--	--	--	--	--	3	1.0	307	99.0
Nasal flaring	--	--	--	--	1	0.3	2	0.6	307	99.0

*NOC - Nursing Outcomes Classification.

Table 3 Correlations between Nursing Outcomes Classification (NOC). indicators and personal characteristics of the patients. Imperatriz, MA, Brazil, 2014-2015

Variables	Present	Absent	Statistics
Age	Mean ranks
Auscultated breath sounds	140.95	171.96	p =0.002*
Oxygen saturation	171.50	138.74	p =0.001*
Gender	Male	Female
Auscultated breath sounds			p =0.015 ^†
Compromised	126	45	OR=0.55
Non-compromised	85	55	IC95%=0.341-0.892
Depth of inspiration			p =0.007 ^†
Compromised	72	19	OR=0.45
Non-compromised	138	80	IC95%=0.256-0.810
Adventitious breath sounds			p =0.029 ^†
Compromised	39	9	OR=0.43
Non-compromised	171	91	IC95%=0.201-0.935

*P-value based on the exact Mann-Whitney test. †P-value based on the Pearson’s chi-square test.

Table 4 Correlations between Nursing Outcomes Classification (NOC). indicators and clinical characteristics of the patients. Imperatriz, MA, Brazil, 2014-2015

Variables		Present	Absent	Statistics
Pain
Dyspnea with mild exertion				p =0.003*
	Compromised	28	7	OR=3.40
	Non-compromised	149	127	CI95%=1.441-8.068
Auscultated breath sounds				p =0.029*
	Compromised	106	64	OR=1.65
	Non-compromised	70	70	CI95%=1.052-2.608
Cyanosis				p =0.039 ^†
	Compromised	6	0	OR=0.56
	Non-compromised	170	133	CI95%=0.508-0.620
Respiratory rhythm				p =0.026*
	Compromised	17	24	OR=0.47
	Non-compromised	160	107	CI95%=0.243-0.924
Type of Anesthesia		General	Local/Regional
Somnolence				p =0.003*
	Compromised	9	4	OR=5.91
	Non-compromised	75	197	CI95%=1.767-19.768
Retracción torácica				p =0.000*
	Compromised	21	14	OR=4.43
	Non-compromised	64	189	CI95%=2.128-9.222
Dyspnea with mild exertion				p =0.000*
	Compromised	18	14	OR=3.64
	Non-compromised	190	67	CI95%=1.719-7.733
Diaphoresis				p =0.047 ^†
	Compromised	7	5	OR=3.51
	Non-compromised	78	196	CI95%=1.084-11.417
Accessory muscle use				p =0.022*
	Compromised	46	80	OR=1.81
	Non-compromised	39	123	CI95%=1.088-3.023
Cyanosis				p =0.002 ^†
	Compromised	5	0	OR=0.28
	Non-compromised	202	80	CI95%=0.236-0.341
Respiratory rate				p =0.024*
	Compromised	33	110	OR=0.55
	Non-compromised	51	94	CI95%=0.330-0.927

*P-value based on the Pearson’s chi-square test. †P-value based on the Fisher’s exact test.

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